Acute Pelvic Pain Flashcards
Differentials
Ectopic pregnancy Ovarian Torsion Fibroid degeneration PID exacerbation Tubo-ovarian abscess
Endometriosis
Endometrial polyps
IBS
Interstitial cystitis
Renal colic
Ovarian torsion presentation
Fluctuating sharp pains before acute onset severe constant pain
Radiates to back
N+V
Ovarian torsion investigations
Basic obs
Bloods - Ca 125, CRP, WCC
USS
- Act before investigations based of of clinical exam
Clinical examination for ovarian torsion
Guarding
Abdominal tenderness
Rebound tenderness
Cervical excitation
Adnexal tenderness
Adnexal mass
Ovarian torsion treatment
Admit
IV fluids
Pain relief
Surgery
Why does fibroid degeneration occur in pregnancy
Oestrogen increases
Increases size of fibroid
Outgrows blood supply
Degradation
Most common cause of PID
Chlamydia
Tubo-ovarian abscess investigations
Pregnancy test Bloods - FBC, CRP, WCC, HCG TV USS First void urine NAAT STI screening Abdominal Xray Diagnostic laparoscopy
Mx of tubo-ovarian abscess
IV abx
IM ceftriaxone + oral doxycline bds + metronidazole bds for 14 days
Surgical drainage
Counselling - risk of infertility
Partner notification for STI
4 hourly observations
Follow up
Haematocolpos
Accumulation of blood within the vaginal due to an imperforate hymen
Haematocolpos presentation
Cyclical pain
Delayed menarche - no bleeding
Haematocolpos examination findings
Speculum - Blueish discolouration at introitus
Haematocolpos treatment
Cruciate incision